PROVISIONAL PROMOTION HUMAN RESOURCES DIVISION
(G.L. Ch. 31, Sec. 15) CIVIL SERVICE UNIT
Form 15A 9/2003
_____State Service _____Municipal Service
City or Town:___________________________ Department:________________________
Division:_______________________________ Bureau:____________________________
To: The Personnel Administrator Date:____________________________
Name of Employee:_____________________________________ SSN:____________________
Position into which provisional promotion is requested:
Title: __________________________________________ Effective Date:__________________
Title of permanent position
from which promoted:_________________________________________________________
One of the following paragraphs must be completed, including signature. If the appointing
authority is not certain that the position is or is not in the next higher grade, he/she should
complete paragraph 2 to prevent any delay in processing.
1. Provisional promotion of the above employee is requested. The position to which promotion
is requested is in the next higher grade.
Signature of Appointing Authority:_______________________________________________
2. Provisional promotion of the above named employee is requested. The position to which
promotion is requested is not in the next higher grade.
(a) Statement of sound and sufficient reason why provisional promotion will be for the
public good.
(b) I hereby certify that there is no employee in the next lower grade and willing to accept.
Signature of Appointing Authority:__________________________________________
The following statement applies on MUNICIPAL PROMOTIONS ONLY:
This is to notify you that I have made a provisional promotion of the person named above.
I have forwarded copies of this letter to the Treasurer and to _____________________________
(Insert title of Auditor, Accountant, etc.)
Requisition No. __________________________________
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